COVID-19 - CMS Accelerated and Advanced Payments

CMS Announces Relief for Medicare Providers and Suppliers Facing Challenges During the COVID-19 Pandemic

March 31, 2020

In line with the recently enacted Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, the Centers for Medicare & Medicaid Services (“CMS”) expanded its accelerated and advance payment program to a broader group of Medicare Part A providers and Part B suppliers. CMS has the authority to provide such accelerated or advance payments during a period of public health emergency to a Medicare provider or supplier who submits a request with the applicable Medicare Administrative Contractor (“MAC”) and who meets the required qualifications. This expansion is meant to lessen the financial hardships providers are facing due to COVID-19, and ensure that providers can focus on patient care and maintain the resources needed to combat COVID-19. To view CMS’ fact sheet regarding the expansion of the accelerated and advance payments program for providers and suppliers during the COVID-19 emergency, please visit here .

Who is eligible to receive accelerated or advance payments?

Any Medicare Part A or Part B provider or supplier throughout the country, including hospitals, doctors, and durable medical equipment suppliers, may request accelerated or advance payments if such provider or supplier:

Billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s or supplier’s request form;
Is not in bankruptcy;
Is not under active medical review or program integrity investigation; and
Does not have any outstanding delinquent Medicare overpayments.

How can providers or suppliers request accelerated or advance payments?

Each MAC has an accelerated/advance payment request form on its website. Texas suppliers and providers can access Novitas Solutions’ Accelerated and Advance Payment Request Form here . Incomplete requests will not be reviewed or processed. Complete requests should include the provider’s or supplier’s identification information, the amount requested based upon need, and the reason for the request. In its fact sheet, CMS notes that most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. Additionally, certain cancer hospitals, inpatient acute care hospitals, and children’s hospitals are able to request up to 100% of the Medicare payment amount for a six-month period. Lastly, critical access hospitals can request up to 125% of their payment amount for a six-month period. Once completed and signed by an authorized representative of the provider or supplier, the Novitas Solutions’ Accelerated and Advance Payment Request Form should be faxed, mailed, or e-mailed to the applicable MAC. CMS notes that electronic submissions will significantly reduce the processing time.

What review does the applicable MAC preform?

Once it receives a complete accelerated/advance payment request, the applicable MAC will validate the provider’s or supplier’s eligibility criteria. Based upon the provider’s or supplier’s preference of e-mail or mail, the applicable MAC will notify the provider or supplier as to whether the accelerated/advance payment request was approved or denied.

When will payments be processed, repaid, recouped, and reconciled?

The provider’s or supplier’s applicable MAC will work to review and issue payments within seven calendar days of the date that the request is received. After the issuance of the accelerated or advance payment, claims may be submitted as usual, and providers and suppliers will receive full payments for their claims. Repayment of the accelerated and advance payments will begin 120 days after the date of issuance of the payment, and is broken out by provider type:

1. Inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals have up to 1 year from the date the accelerated payment was made to repay the balance. One year from the accelerated payment, the MACs will perform manual checks to determine if there is a remaining balance. If a balance is remaining, the MACs will send a request for repayment of the remaining balance, which is collected by direct payment.

2. All other Part A providers and Part B suppliers have 210 days from the date the accelerated or advance payment was made to repay the balance.

There are two methods whereby accelerated or advance payments will be recovered from the receiving provider or supplier:

For Part A providers who receive Period Interim Payment, the accelerated payment will be included in the reconciliation and settlement of the final cost report (i.e. 180 days after the fiscal year closes).

All other providers and suppliers will begin repayment of the accelerated or advance payment 120 calendar days after payment is issued.

Every claim submitted by the provider or supplier will be offset from the new claims to repay the accelerated or advance payment. Thus, instead of receiving payment for newly submitted claims, the provider’s or supplier’s outstanding accelerated or advance payment balance will be reduced by the claim payment amount. The process is automatic.

Are appeals available to providers and suppliers?

Providers and suppliers will not have administrative appeals rights related to these accelerated or advance payments. Notwithstanding the foregoing, administrative appeal rights would apply if CMS issued overpayment determinations to recover any unpaid balances on accelerated or advance payments.